Provider Demographics
NPI:1972759512
Name:KIRBY, KELLY C (MS, LPCC)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:C
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 HUFF ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3330
Mailing Address - Country:US
Mailing Address - Phone:507-358-4380
Mailing Address - Fax:320-323-4616
Practice Address - Street 1:577 HUFF ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3330
Practice Address - Country:US
Practice Address - Phone:507-358-4380
Practice Address - Fax:320-323-4616
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101Y00000X
MNCC00277101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN150913OtherUCARE
MN256057700Medicaid
MN3H671EIOtherBLUE CROSS/BLUE SHIELD
MN6212367OtherUBH
MN800000244Medicare UPIN